Abstract
OBJECTIVES:Zika virus, which was first discovered in 1947, has become a global threat to human health as it is rapidly spreading through Latin America, the Caribbean, the US and Asia, after causing a large outbreak in the Northeast region of Brazil in 2015. There is ample evidence to support that Zika virus is associated with neurological complications such as microcephaly. The review aims to provide an overview on the complex issues involved in the emergence of Zika virus’s neurological disorders and to discuss possible explanations of Zika virus introduction and dissemination in Brazil. We also suggest national and global strategies to adequately respond to the Zika virus emergence.METHODS:We provide an analytical evaluation of the main issues related to the Zika outbreak in Brazil, based on available scientific literature, including government documents, and on epidemiological information from national surveillance databases.RESULTS:The studies on the clinical manifestations of the Zika virus infection coupled with the epidemiological surveillance information in Brazil have provided significant evidence that the Zika virus is associated with neurological disorders such as microcephaly and Guillain-Barré syndrome. Based on phylogenetic and molecular analysis, the hypothesis regarding the introduction of Zika virus in the country is that it took place following international events in 2013 and 2014, when many foreign visitors could have brought Zika virus into Brazil. The immunologically naïve status of populations in the Americas, previous infection with dengue virus, and the increased activity of Aedes aegypti might be the contributing factors for such an outbreak in Brazil. The Zika virus emergence emphasized the importance of cross-disciplinary perspective. Besides the scientific-based vector control strategies, it is important to understand the nature of the evolutionary processes involved in the viral evolution in complex ecosystems and to have social and anthropological knowledge on the conditions related to the spread of the disease in order to properly respond to the spread of the Zika virus.CONCLUSIONS:The experiences of Brazil have demonstrated the significance of multi-disciplinary approach in response to new and resurgent arboviral diseases and provided important lessons that could be applied to other developing countries.
Highlights
Zika virus was first discovered in Uganda in 1947, and the first human case was documented in 1952 [1]
Since the report of the first autochthonous case of Zika virus infection in Brazil in May 2015, Zika has begun to spread to other countries in Latin America and the Caribbean, as well as to the US
The Emergency Operations Center of the US Centers for Disease Control and Prevention (CDC) was activated, with a level 1 activation announced on February 8, 2016
Summary
Zika virus was first discovered in Uganda in 1947, and the first human case was documented in 1952 [1]. Before 2015, the virus was limited to Africa, Southeast Asia, and the Pacific Islands. Since the report of the first autochthonous case of Zika virus infection in Brazil in May 2015, Zika has begun to spread to other countries in Latin America and the Caribbean, as well as to the US. Following the establishment of the a surveillance protocol for Zika virus infection-related microcephaly by the Brazilian National Response Plan, the Pan American Health Organi- A recent review study leaded by CDC investigators concluded that a causal relation can be inferred and the Zika virus can cause microcephaly if a woman is infected during pregnancy [4]
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